Biodegradable, non-toxic biological adhesive for use in abdominal surgery

ABSTRACT

A biological adhesive formulation comprising dextrin, at least one adhesiveness modifier agent, and at least one antibiotic is suitable for promoting healing of tissue in a patient, for example, to prevent anastomosis of a surgical wound in the digestive system of a patient, and for affixing a prosthesis during a hernia operation.

This application claims the benefit of U.S. Provisional Application Ser.No. 60/762,136, filed Jan. 26, 2006, the entire disclosure of which ishereby incorporated by reference.

FIELD OF THE INVENTION

The invention relates to a biological adhesive for surgical use inhumans. In particular, this invention relates to a biologically adhesiveformulation that is biodegradable, non-toxic, offers temporaryprotection of anastomosis within, for example, the gastrointestinaltract, and reduces or eliminates to the maximum dehiscences and theirserious consequences. Additionally, the present invention relates to atemporary adhesive to affix a prosthesis during inguinal hernioplastiesand an adhesive for occluding fistulas.

BACKGROUND OF THE INVENTION

The capacity to unite biological tissues and/or to protect these unions(i.e., “anastomosis”) has been an area of very important research forthe biomedical investigators for several decades.

One of the greater problems that plague patients and surgeons world-wideis proper healing of an anastomosis within the gastrointestinal systemand those of other systems as well. Dehiscence or faulty healing of theanastomosis may occur even though the anastomosis is well indicated, inthe appropriate patient, and is adequately performed. Some dehiscencescarry a high mortality rate (30-50%) and their complications requireurgent reoperations and prolonged hospitalization in the intensivetherapy units involving, for example, parenteral nutrition, complicatedrespiratory care, prolonged and costly antibiotic-therapy, numerouslaboratory tests, etc.

At the present time, obesity has reached epidemic proportions throughoutin the world, in developed as well as in underdeveloped countries. Forexample, in the United States of America one of every three adults isobese and approximately 5% suffer from morbid obesity, i.e., a body massindex (BMI) of 35 kg/m² or greater, and, what is worse, 1 of each 6children suffers from obesity^(1,2). Although numerous medicaltreatments exist, these treatments only aid those patients with lowerdegrees of obesity, or in the short term, patients with morbid obesity,since, although initially the patients loose weight, a follow-up 10 to15 years after the treatment demonstrates that 98% of the patients havereturned to their initial levels of obesity (“bounce”). Thus, theyremain obese and frustrated.¹⁻⁴ Morbid obesity is recognized at thepresent time as a chronic, incurable multi-factorial disease, theeffects of which damage several organ systems that not only decrease theduration of life, but also the quality of life as well. Obesity affectsthe organism through the so-called co-morbidities, the most importantones being diabetes mellitus II, arterial hypertension, ischemicaccidents of the heart and the cerebral circulation, serious pulmonarycomplications such as sleep-apnea, pulmonary disease of the obese,thromboembolic accidents, gastroesophageal reflux, severalosteo-articular disorders, alterations of fertility, urinaryincontinence, dislipidemias, etc¹⁻⁶. Moreover, objective evidence existsthat obesity is a predisponent factor for the development of severalmalignant tumors such as breast cancer, colon-rectal cancer, prostatecancer, endometrial cancer, myelomas, leukemias, etc.¹⁻⁴

Since the world-wide consensus meeting of 1991 in the United States ofAmerica, at the National Institutes of Health (NIH),⁴ it has beenconcluded that surgery is the only effective method for the control ofthe complications of obesity. With the introduction of the laparoscopicsurgery everywhere in the world, the number of procedures of Bariatricsurgery has increased in exponential form. But, due to economic reasonsin some regions of the world, it is still practiced in conventional oropen technique, which is also appropriate.¹⁻⁶

The two main causes of mortality, major complications and enormous costsof gastric bypass, bilio-pancreatic diversions, etc., are the improperhealing of the anastomosis called dehiscence (a premature bursting openor splitting along a surgical suture line, like in the junction orconnection between the ends of the intestine, or the stomach pouch andthe intestine as in the gastric bypass) and pulmonarythromboembolism⁵⁻⁸. The prevalence of the first varies from 1 to 5% ingeneral, it being less in some groups with more experience⁶⁻¹³. Themortality caused by the anastomotic dehiscence ranges from 30 to 50%.Serious peritonitis ensues in patients that are already complicated withpulmonary, circulatory problems, etc., and require immediate and urgentreoperations, as well as special treatment in an intensive care unit, asmentioned before, which is extremely expensive. The cost for thepatients who survive is approximately $ 100,000 USD¹². If 200,000 annualprocedures are practiced in the USA, and if the prevalence of leaks is2% (that at general level is greater), this would mean that the cost ofthese complications would be more than 20 million dollars annually,without taking into account indirect costs of the family, medico-legaland others.

This feared anastomotic dehiscence also occurs in surgery of the colonand rectum. The complications of diverticular disease are more and morefrequent in patients older than 50 years (considering that lifeexpectancy continues to increase everywhere in the world), like ischemicaccidents, malignant tumors, volvulus, etc. The prevalence ofdehiscences in anastomosis of the colon and rectum is greater than inBariatric surgery and ranges from 5 to 15% of the cases reported ingeneral. Also, mortality in these patients is greater, and the expensesin the intensive care unit are also very high for obvious reasons¹⁴⁻²¹.Colonic dehiscences, in addition, diminish survival rates for patientsoperated on for cancer²². When these patients are operated in electiveor emergency situations, it is necessary to extirpate a segment ofintestine. In debilitated, older patients, frequently with peritonitis,it is not possible to practice a primary anastomosis, but instead it isnecessary to perform a colostomy or ileostomy. Colostomies save manylives but nobody likes them. They require special care in all patients,and almost all patients want to be re-operated on so that the intestinecan be re-connected and they can live normally. But, that also meansanother surgery, additional risks, expenses, etc.

Because endoscopic surgery is already accepted internationally asadequate for colon cancer treatment^(16.21), as for well asnon-malignant diseases¹⁷⁻²⁰, the number of these procedures performedwill increase, as happened with cholecystectomy, antireflux surgery,nephrectomy for renal donor and many other procedures.

In the esophagus, the situation is more serious than in the colon, sincethe organ does not have a serous layer and anastomotic leaks (forexample, in resections for tumors, congenital diseases, caustic burns,antireflux reoperations, etc.) produce mediastinitis with very highmortality rates.²³⁻²⁵

It was mentioned previously that anastomosis can present dehiscences inspite of being well indicated, well done manually, with staples or usinga mixed technique, without tension, with good blood supply, with goodnutritional status, without peritonitis, regardless of being elective orurgent. It is very important to mention that dehiscences appear betweenthe second and tenth postoperative day, but 98% occur between the secondand sixth post operative day.^(26,27)

During the 2^(nd) thru the 8^(th) postoperative day, the anastomosisdoes not have any strength by itself. In this time period, collagendeposition and new tissue bridges have not yet been built across the twoends (2^(nd) phase of healing process). As a result, the anastomosis isvery weak, inflamed due to the presence of sutures and staples (foreignbodies) and bacteria, clots, etc. It is precisely during this timeperiod that anastomosis leaks (or failures) often occur with the ensuingvery grave and often lethal complications.

Anastomotic dehiscences, like a perforated duodenal ulcer, initiallyproduce a discharge of gastrointestinal secretions that cause anintense, localized inflammatory reaction called “chemical peritonitis.”Later on, the discharge process continues and more secretions andbacteria are discharged producing secondary peritonitis, a most fearedcause of mortality.²⁷⁻²⁹

In the case of peritonitis by perforation and/or dehiscence of thecolon, the peritonitis is of fecal type from the beginning and thereforeof greater gravity in patients that, e.g., due to their age, othercardio-pulmonary ailments, metabolic complications, malnourishment,etc., have a greater surgical risk from the outset.¹⁷⁻²⁰

In the esophagus, something similar happens with the discharge ofdiverse pathogenic germs in the mediastinum. Some groups such asSchardey et al. of Germany, affirm, based on their experimental andclinical observations, that “. . . it can be prevented that thepotentially pathogenic germs associated with the micro-leaks are incontact . . . and produce these dehiscences.” by means of the use ofintensive antibiotic therapy.^(23.24)

A person knowledgeable in the area knows that in mammals in the healingprocess there are 3 main phases. The first phase starts immediatelyfollowing the traumatic event with clotting accompanied by acuteinflammation and, only after 7-8 days, the collagen deposition or secondphase begins. The resultant scar is remodeled in the 3rd phase and then,there is considerable strength in this area weeks later. In theintestinal anastomotic area there is acute inflammation, clots, bacteriaand secretions and it is known that during these days there is nocollagen deposition in the edges. For this reason, the segments ofintestine are held only by the sutures and/or staples, without bridgesof new tissue to join both ends, but the anastomosis itself does nothave any intrinsic firmness or strength per se. It is precisely in thiscritical period that most anastomotic failures or dehiscences occur.(Wasserberg N, Tzakis A G, Santiago S F, Ruiz Ph, Salgar Sh K.,Anastomotic healing in small bowel transplantation model in the rat,World J Surg 2004;28:69-73.). The method and adhesive herein describedprovide protection of the anastomosis during these critical days toprevent a dehiscence or failure to heal adequately.

In the case of fistulas that can be a consequence of an anastomoticdehiscence or trans-operative trauma, etc., they represent a veryserious and annoying complication of various surgical procedures andsome diseases of diverse organ systems like the gastrointestinal,respiratory, urinary, etc. When fistulas are not accompanied byobstruction or complicated with active suppuration, one can try toobliterate them with different methods or sealants with variableresults^(30-33.)

In inguinal, incisional and other parietals hernias, the “gold standard”surgical treatment nowadays is called “without-tension” wherein aprosthesis or mesh is placed in the defect.³⁴⁻³⁷. Fixation of thisprosthesis can be performed in several ways to avoid its displacement,both in open or laparoscopic surgery, frequently using sutures orstaples. Staples are very expensive and, like sutures, they canincorporate, catch or compress small nerves, or produce osteo-condritisand post operative pain. Post operative neuritis is one of the frequentand important complications in inguinal hernia operations and,unfortunately, a frequent cause of reoperations and legal actions. Theeffect of fixation in this case is also temporary since after 4 to 5days the prosthesis is included by the local connective tissue and nolonger will be displaced³⁷. A brief inspection in the surgicalcongresses and current literature shows that great interest exists tofind an effective and safe method of affixing prosthesis in thesesituations. In fact, novel methods and alternatives are continuouslydescribed.^(38,39)

U.S. Pat. No. 6,046,178 discloses a “wound treating” compositioncomprising a starch hydrosylate, such as maltodextrin, for treating openwounds or gaps in the skin tissue as in the treatment of burns, ulcers,lesions, and other skin defects. The starch hydroxylate is combined withsterile water and a gelatinization agent such as glycerin to form anemulsion. The starch hydroxylate mixes with the proteins in the woundfluid and forms a film that ultimately adheres to underlying tissue. Theformed film is semi-permeable to air and fluid. U.S. Pat. No. 6,046,178does not teach or suggest an adhesive or glue to be used in surgicalpractice for temporarily reinforcing and protecting the anastomosis ofthe digestive system (and of other organ systems), nor occludingfistulas nor affixing prosthesis in inguinal hernioplasties.

U.S. Pat. No. 5,985,312 describes using metal compounds such as zincoxide to enhance the bioadhesiveness of polymers used in drug deliverydevices such as microspheres, tablets, capsules, which contain a drug ora diagnostic agent. U.S. Pat. No. 5,985,312 does not suggest abioadhesive polymer such as polysaccharide for use in surgical practicefor temporarily reinforcing and protecting the anastomosis of thedigestive system (and of other organ systems).

U.S. Pat. No. 4,600,574 disclose a tissue adhesive in which atissue-compatible material such as polysaccharide is combined with asolution comprising fibrinogen and Factor XIII. Due to the presence offibrin, this adhesive suffers from the disadvantages as discussedfurther below.

U.S. Pat. No. 5,496,872 disclose a non-toxic, biodegradable adhesivecomposition for surgical use. The composition contains a compound havingat least two relative functions which can be used in combination with abiodegradable, synthetic or natural polypeptides such aspolysaccharides.

SUMMARY OF THE INVENTION

Thus, in accordance with the invention, there is provided a techniqueinvolving a tissue adhesive or glue that protects and/or promotes thenormal healing of tissues. This technique solves at least some of theproblems associated with leaking of anastomosis and affixing prosthesisin inguinal and other hernia operations. Additionally, there is provideda composition for use in the above mentioned technique.

According to a further aspect of the invention, there is provided abiological adhesive formulation comprising dextrin as a dispersion, atleast one adhesiveness modifier agent, and at least one antibiotic,wherein the formulation contains 80-97 weight % of the dextrindispersion, and the dextrin dispersion contains 45-75% solids, based onthe total weight of the formulation. According to a further aspect ofthe invention, there is provided a biological adhesive formulationconsisting essentially of dextrin as a dispersion, at least oneadhesiveness modifier agent, and at least one antibiotic, wherein theformulation contains 80-97 weight % of the dextrin dispersion, and thedextrin dispersion contains 45-75% solids, based on the total weight ofthe formulation.

According to a further aspect of the invention, there is provided abiological adhesive formulation comprising dextrin as a dispersion, atleast one adhesiveness modifier agent, and at least one antibiotic,wherein the formulation contains 80-97 weight % of the dextrindispersion, the dextrin dispersion contains 45-75% solids, based on thetotal weight of the formulation, and the formulation has a viscosity of12,000-25,000 cp, preferably 15,000-18,000 cp.

According to another aspect of the invention, there is provided a methodfor promoting healing of tissue in a patient comprising applying to thetissue an adhesive formulation comprising dextrin, at least oneadhesiveness modifier agent, and at least one antibiotic. Preferably,the adhesive formulation comprises dextrin as a dispersion, at least oneadhesiveness modifier agent, and at least one antibiotic, wherein theformulation contains 80-97 weight % of the dextrin dispersion, and thedextrin dispersion contains 45-75% solids, based on the total weight ofthe formulation.

According to another aspect of the invention, there is provided a methodfor preventing dehiscence of an anastomosis in a patient, comprisingapplying an adhesive formulation comprising dextrin, at least oneadhesiveness modifier agent, and at least one antibiotic. Preferably,the adhesive formulation comprises dextrin as a dispersion, at least oneadhesiveness modifier agent, and at least one antibiotic, wherein theformulation contains 80-97 weight % of the dextrin dispersion, and thedextrin dispersion contains 45-75% solids, based on the total weight ofthe formulation. According to a preferred embodiment, the wound iswithin the digestive system and the adhesive formulation protectsagainst dehiscences of anastomosis of the digestive system.

According to another aspect of the invention, there is provided a methodfor affixing a prosthesis during a hernia operation in a patient,comprising applying an adhesive formulation comprising dextrin, at leastone adhesiveness modifier agent, and at least one antibiotic.Preferably, the adhesive formulation comprises dextrin as a dispersion,at least one adhesiveness modifier agent, and at least one antibiotic,wherein the formulation contains 80-97 weight % of the dextrindispersion, and the dextrin dispersion contains 45-75% solids, based onthe total weight of the formulation. According to a preferredembodiment, the hernia operation is for an inguinal hernia.

According to another aspect of the invention, there is provided a methodfor occluding a fistula within a patient comprising applying to thefistula an adhesive formulation comprising dextrin, at least oneadhesiveness modifier agent, and at least one antibiotic. Preferably,the adhesive formulation comprises dextrin as a dispersion, at least oneadhesiveness modifier agent, and at least one antibiotic, wherein theformulation contains 80-97 weight % of the dextrin dispersion, and thedextrin dispersion contains 45-75% solids, based on the total weight ofthe formulation.

Multiple efforts have been made to develop synthetic polymers, such as,for example, the cyanoacrylates, as adhesives and sealants. The tissueadhesive disclosed in U.S. Pat. No. 3,667,472 (Halpern) relates to thesurgical use of monomeric adhesives of C₂-C₄ alpha-cyanoacrylate. Thistissue adhesive cures on contact with water or blood to form a solidlayer which crystallizes over the tissue. Nevertheless, a disadvantageof this class of adhesives is that it is contraindicated for applicationin internal organs or vascular surgery, and therefore in anastomosis,due to its toxicity and oncogenic effects which have been welldocumented^(30-31.)

The well-known toxicity associated with synthetic adhesives has ledinvestigators to develop biologically derived adhesives for use as unionmaterials. One type of biological adhesive or glue is obtained fromfibrin. Commercially, tissue adhesives of fibrin are derived from humanplasma and thus raise potential risks to human health. Fibrin (and itsderivatives) has been used in formulating biomedical adhesives withvariable results from the experimental point of view and prospectivestudies in humans cannot be done for logical reasons. Its use for theprotection of anastomosis has had apparently favorable results in a fewreports. It is the only adhesive of use that is more or less accepted,but it is neither popular nor routine^(31, 32, 41-43). Nevertheless,fibrin has several disadvantages: risk of viral transmission like anyother cryoprecipitate exists; use of fibrin requires processes forextraction of blood; costs associated with fibrin are high; it requiresa special applicator; risk of allergic reactions is always present; anda fatality has been reported. Another disadvantage with fibrin is thatthe adhesion force is relatively weak compared to other adhesives.

More recently, combinations of products have been devised to be used asadhesives and tissue sealants. One such combination that has beendescribed is the use of a combination of three substances preparedseparately, i.e., the cryoprecipitate of human fibrinogen, thrombin inthe presence of the calcium ion, and concentrated factor XIII, used toobtain a glue biomedical applications. Nevertheless, this type ofproduct and systems of adhesives available do not avoid the healthproblems described before. Attempts have been made to isolate ananalogous component that contains fibrinogen (to see, for example,Feldman, M. C., ET al., Arch Otolaryngol-Head and Neck Surg (1988)114:182-185; Feldman, M. C., ET al., Arch Ophthalmologic (1987)105:963-967; Feldman, M. C., ET al., M J Otology (1988) 9:302-305;Silberstein L. E., ET to, Transfusion (1988) 28:319-321). However, theuse of preparations of the analogous fibrinogen also has obviouslimitations.

In summary, there is an acute need of a useful biomedical adhesive orsealant formulation that can be used in daily surgical practice toprovide a fast and safe way to temporarily reinforce and protect theanastomosis of the digestive system and of other organ systems.Particularly, there exists need of a biological adhesive that allowseffective temporary protection of the anastomosis between the second andsixth postoperative day, which is not toxic, does not produce seriousadverse reactions, and minimizes demands on surgical resources and time,coupled with a superior biocompatibility and biostability. Additionally,such compositions preferably offer improved resistance to leakage whereapplied, without affecting the original physiological functions of thedigestive system and other organ systems. Optimally, this formulation isinexpensive, in these present times of “cost containment”.

These properties of the biological safe adhesive make it also useful foraffixing prosthesis in different types of hernia operations.

Considering these needs, an aspect of the present invention is toprovide an adhesive formulation based on a dextrin, which is safe andeffective, and which has the following characteristics and properties:

i) Non-toxic. The dextrins are not toxic to human beings.

ii) Minimizes micro-leaks of liquids. Because dextrins have specialproperties to seal porous structures, their use in an adhesive providesan improvement over the other well-known agents.

Iii) Adherent. Due to their adhesive properties, formulations of thepresent invention bind tissues through mechanical, chemical and/orelectrostatic connections or unions among them, their surfaces and themicroscopic spaces that exist between sutures or staples^(44,47).

iv) Resistant to bacterial colonization. Dextrins have antibacterialproperties that are useful for the protection of anastomosis where“micro leaks” could occur between the microscopic spaces that exist insutures or staples, mainly discharges of secretions and bacteria.

v) Biodegradable and safe. Although the adherent strength of dextrinscan persist for many weeks or months in the external atmosphere, thehuman body has the capacity to metabolize them and to turn them intosimple carbohydrates that are absorbed without any adverse consequence.The FDA and the National Research Council have indicated thatapprovability of biological adhesives will be enhanced where a minimumamount of solvent is used and the polymer is biodegradable.

Therefore, another aspect of the present invention is to provide aformulation based on a dextrin as an effective, safe, biologicaladhesive, with appropriate adherent strength for biomedicalapplications, particularly those that involve smooth tissues. Morespecifically, the present invention is directed to useful compositionsthat temporarily protect anastomosis to eliminate dehiscences to themaximum, and that, in addition, can serve as an adhesive for inguinalprosthesis in hernia operations and for occluding certain types offistulas.

In the present invention, another aspect of the composition based ondextrin is to combine a dextrin with other agents that confer additionaldesirable characteristics and also avoid adhesions with the surroundingorgans and structures, for example, an interface of cellulose orcollagen can be included to avoid such adhesions.

BRIEF DESCRIPTION OF THE DRAWINGS

Various features and attendant advantages of the present invention willbe more fully appreciated as the same becomes better understood whenconsidered in conjunction with the accompanying drawings, in which likereference characters designate the same or similar parts throughout theseveral views, and wherein:

FIG. 1 shows the results of a test to determine the hydraulic pressurerequired to produce a leak (“bursting pressure”) in suture lines in therat's intestine, Phase 1. (Test ANOVA);

FIG. 2 is a microphotograph of a segment of the intestine of a rat fromgroup 1 that died in 3 days, in which the defect was covered with apatch, but not an adhesive or suture, Phase 2;

FIG. 3 is a microphotograph of a segment of the intestine of a rat fromgroup 1 that survived 3 weeks, in which the defect was covered with apatch but not adhesive or suture, Phase 2;

FIG. 4 is a microphotograph of a segment of the intestine of rat fromgroup 2, in which a patch was placed with the biological adhesive of thepresent invention, Phase 2;

FIG. 5 is a photograph showing the macroscopic aspect of the duodenumthree weeks after placing a patch with adhesive in a dog, Phase 3; and

FIG. 6 is a microphotograph showing the microscopic evaluation of theduodenal injury of a dog after three weeks, Phase 3.

DETAILED DESCRIPTION OF THE INVENTION

The term “dehiscence” used presently includes any defect or failure ofthe anastomosis in the gastrointestinal, respiratory, urinary systems,etc., that can produce leakage of secretions and bacteria through thisdefect, with very serious and frequently lethal consequences. Thisstatement is not to be considered limitative but rather illustrative ofsome of the applications of the biological adhesive of the presentinvention to eliminate dehiscences of anastomosis to the maximum.

The terms “adhesive formulation” and “adhesive” are used in aninterchangeable indistinct way and mean any biological adhesive thatoffers protection.

The adhesive formulation of the present invention is biodegradable,non-toxic, safe and effective, and has the capacity to provide temporaryprotection of anastomosis for several days, particularly during “thecritical days” in order to enhance healing. It must be understoodclearly that the adhesive formulation of the present invention is not asubstitute for good surgical techniques, but an additional element ofprotection.

In an aspect of the present invention, the adhesive formulation isconstituted mainly by a natural product, and which is easy to use andinexpensive. The formulation has demonstrated to have very usefulproperties in experiments made in minor and major animal species, and isvery well tolerated and biologically degraded, (depending on thephysico-chemical mixture and concentration of additional components),after the 10th post operative day without any collateral or undesirableeffect.

In another aspect of the invention, the adhesive formulation can be usedwith such similar results for temporary fixation of prosthesis ininguinal hernia operations (and others as well). In addition, theadhesive can be used to facilitate the closing of some digestivefistulas or fistulas of other organ systems, if there is no obstructionor active suppuration.

In agreement with the previous statement, the biological adhesive of thepresent invention has the characteristics and properties, such as, itallows effective temporary protection of the anastomosis between 2° and10° postoperative days, is not toxic, and does not produce adversereactions or risks of transmission of infectious agents. It minimizesthe demands on surgical resources and time, and demonstrates superiorbiocompatibility. In addition, the biological adhesive of the presentinvention offers improved convenience and permanence compared toformulations presently available. Also, the inventive formulation,promotes treatment of the patient, and reduces hospital stays and/ormedical supervision. Additionally, the strength of adhesiveness of thepresent invention does not affect the normal physiological functions ofthe digestive system and other organ systems, where it is applied.

An important advantage of the inventive biological adhesive is that theadhesive effectively can protect the anastomosis during the crucial timeperiod between the 2nd and 8^(th) postoperative days. It is during thistime period that the anastomosis is particularly week because collagendeposition and development of new tissue bridges (2^(nd) phase ofhealing process) has yet to occur.

Another important advantage of the inventive biological adhesive is itsnon-toxic nature, thereby allowing the formulation to be used as aninternal biological adhesive for anastomosis, without the safetyconcerns associated with, for example, biological adhesives obtainedfrom fibrin that are very expensive, and complicated to use.Additionally, in this time of cost containment, the biological adhesiveof the present invention is extremely inexpensive.

Once again, this biological adhesive contains a material offundamentally natural origin that has the property to adhere to tissuesand/or live structures (call “bio-adhesion”) for a determined period oftime. So, in order for this “bio-adhesion” to be effective, an intimatecontact between the adhesive material and the receiving tissue mustexist. Preferably, the adherent material makes not only direct contactwith the surface of the tissue and/or live structure, but alsopenetrates into the hollows or grooves of the receiving tissue so thatmechanical, chemical and/or electrostatic connections or unions or linksare formed. Of course, the adherent property of the material will beaffected by certain factors, such as the physical and chemicalconditions where it is applied^(44-47.)

The biological adhesive of the present invention includes a dextrin, anadhesiveness modifier agent and an antibiotic. Each one of thecomponents of the biological adhesive is present in suitable amounts toprovide the characteristics and properties previously mentioned.

The term “dextrin” as it is used in the present invention means aglucose polymer that forms from starch hydrolysis and which has glucoseunits connected by α-1,4 or α-1,6 links. As it is known, dextrins arehydrosoluble polysaccharides (dextro-rotatory polymers) of diversemolecular weight and chemical structure, obtained from partialhydrolysis of starch. In biological systems, this conversion takes placeby the enzymatic action of α-glycosidases or dextrinases, butindustrially the conversion is carried out by means of acids, heating orboth. The dextrins are not susceptible to fermentation, and haveantibacterial properties. Dextrins exist with a high or low level ofconversion (hydrolysis). In general, the former are more hydrosoluble,whereas with greater solid concentration (for example, borax, asdiscussed below) the greater the adhesiveness. Dextrins also existnaturally in some vegetables during the process of germination andmaturation. The dextrins also can be classified as white dextrins(greater viscosity), yellows (greater adhesiveness) and “British gum”,which have a high degree of conversion.

Preferred dextrins for use in the formulation of the biological adhesiveof the present invention are those that exhibit a viscosity of12,000-33,000 cp (for example, 15,000-32,000 cp, or 12,000-25,000 cp, or15,000-25,000 cp, or 15,000-18,000 cp, or 30,000-32,000). In preferredembodiments of the invention, a dextrin such as maltodextrin is used atone of two different concentrations: (1) maltodextrin with a viscosity12,000-18,000 cp (such as 15,000-18,000 cp), especially 12,000-16,000cp, wherein the resultant composition is in the form of a suspensionwhich is easy to apply and has the above mentioned properties, and (2)another maltodextrin with a higher viscosity (e.g., 30,000-32,000 cp),wherein the resultant composition is in the form of a paste. Theseviscosity ranges are based on the formulation containing dextrin, thecarrier (e.g., water), and an adhesiveness modifier (e.g., borax or zincoxide). It is believed that the antibiotic will have little effect onthe viscosity.

In embodiment (1) mentioned above, the resultant adhesive compositionneeds between about 10-12 minutes to cure (based on animal tests) andproduce the desired adhesiveness. In embodiment (2) mentioned above, theresultant adhesive composition has a higher concentration of zinc oxideand/or borax and thus requires only 5-6 minutes to cure (based on animaltests), but due to this characteristic the composition is applied as apaste and produces minimal adhesions to surrounding fatty tissues. Asnoted, the estimated curing times mentioned above are based on acuteanimal experiments wherein curing times were measured in thedetermination of the bursting pressure of a suture line. In clinical usein humans, the adhesive formulation will obviously be allowed tosufficiently cure and will remain in place for several days protectingthe anastomosis, or affixing the prosthesis, or occluding the fistula,and then later on will be metabolized.

In the formulation, the dextrin is used in the form of a mixture orsuspension with a pharmaceutically acceptable carrier/excipient such aswater. This mixture/suspension can have a solids content of, forexample, 45-75%, preferably 55-70, especially 60-68%.

The addition of some solids to the dextrin, for example, boraxhydroxide, iron, zinc, etc., modifies certain properties of the dextrinssuch as viscosity, drying time and adhesiveness.

The dextrins have been used commercially in diverse forms for severaldecades, like as adhesives for paper, pasteboard, packages, etc. Inspite of daily frequent contact with the skin and human digestivesystem, no toxic effects are known. In fact, certain types of dextrins,for example, malto-dextrins, are used for the manufacture of beer.

The selection of the dextrin as the main component of the presentinventive adhesive formulation or biological glue—for use as safe,temporary protection of anastomosis of the gastrointestinal,respiratory, urinary systems, and to fix the prosthesis of herniaoperations among other clinical uses—is based on several months ofextensive tests with diverse products, on a large number of inorganicmaterials and, later on, derived from experimental work in minor andmajor animal species, under a strict research protocol. As mentionedpreviously, the selection of dextrins is based, in addition, on thefollowing properties and/or characteristics:

Non Toxic for Humans

After several decades of commercial use of dextrins in adhesives, withdaily, direct contact to the skin, the mucosa and the lips, etc., notoxic or adverse effects are known. In addition, an extensive literaturesearch does not reveal any evidence of toxicity. High-residue foods suchas complex carbohydrates, including dextrins and similar compounds, areingested daily by human beings without any toxicity, and relatedcompounds (maltodextrins) are used in the production of the beer. Theyare also used in the manufacture of capsules, etc.

Recently, sulphated dextrins have been used successfully in humans by agroup of investigators at Hammersmith Hospital of London, whereinsulphated dextrins were administered intraperitoneal to patients withKaposi's Sarcoma, since they have the property to inhibit theangiogenesis in this tumor. A favorable response by its use was observedwithout undesirable effects, i.e., they were well tolerated, even inthese very sick patients⁴⁸.

Use of icodextrins is common in peritoneal dialysis in concentrationsfrom 4 to 7 %^(49,50). An example of the use of icodextrins is disclosedin U.S. Pat. No. 6,770,148, issued 3 of Aug. of 2004, and entitled“Solution for peritoneal dialysis that contains modified icodextrins”.Other groups recently have used intraperitoneal icodextrins in womenwith reproductive problems. Apparently, pelvic adhesions decreased andno collateral or toxic effects were observed, only a single report of aminor allergic reaction 51,52

Cyclodextrins have special properties that allow them to improve thestability, solubility and bioavailability for oral absorption of somedrugs, and they are used accordingly. Cyclodextrins are degradedenzymatically in the digestive lumen, mainly in the colon, and no toxiceffects are known. Due to the mentioned properties, use of cyclodextrinsintravenously is under investigation at the present time with greatinterest⁵³.

Maltodextrins also are used orally in solutions for rehydration, and inpill manufacture, etc., without any reports of toxicity.⁵⁴

Finally, it must be remembered that a compound closely related todextrin from a biochemical point of view, that is, a modified starch(hydroxy-starch), is frequently used intravenously in emergencysituations in humans as a volume-expander.⁵⁵

In the studies discussed below, maltodextrin is used. Maltodextrin,derived from vegetables and, in industrial processes, mixed with borax(2-4%), has been used as glue commercially for decades. However, sinceother dextrins share similar physic-chemical properties, the applicantconsiders that they can also be used for similar purposes in accordancewith the invention. In fact, they are used frequently in humans indifferent medical applications successfully. Maltodextrins are non-toxicand are used commercially in the food-processing business. They areingested daily in many places in the world and are easily digested inthe GI tract to form glucose.

Resistant to Bacterial Invasion

Dextrins have antibacterial properties. This property is of particularimportance in biological adhesives for protection of anastomosis wherethe “micro leaks” of secretions and bacteria between microscopic spacesof sutures or staples can occur, where germs make contact with organsand intraperitoneal and/or intrathoracic structures, or with foreignbodies like a prosthesis with very serious consequences.

High Penetration in Hollows or Grooves

The application of dextrins in porous substrates such as paper andcardboard, has demonstrated their high capacity to penetrate hollows orgrooves on and through surfaces to which they are applied. Therefore,penetration into grooves or hollows of the receiving tissue is animportant property of dextrin, with respect to microscopic defects inthe anastomosis (denominated “micro leaks” of liquids and bacteriapresent in the lumen of the digestive system).

High Resistance to the Humidity

Adhesives based on dextrin exhibit a high environmental resistance tohumidity. This characteristic is important because the adhesive can thusbe applied in an internal cavity with normally high humidity. Also, thedextrin will work as an adhesive at the human body temperature.

Biodegradable

Although in an external environment the strength or force of theadhesion can persist for many weeks or months, dextrin's force orstrength of adhesion in the human body is temporary, due to the capacityof living human tissues to metabolize the adhesive. The resultingproducts are simple carbohydrates that are eliminated or absorbedwithout adverse consequence. When metal oxides are used to increase theviscosity and the tack, the adhesive of the present invention can beobserved to adhere to the intestinal segment for up to 3 weeks later. Inthis case, if an interphase is not used, some adhesions to theneighboring intestinal loops may occur.

Very Inexpensive

The cost of the adhesive according to the invention is approximately,$2,000.00 pesos ($ 200 USD) per 60 kg.

Preferred dextrins (in admixture with a pharmaceutically acceptablecarrier/excipient such as water) for use in the formulation of thebiological adhesive of the present invention are those that exhibit aviscosity of 12,000-33,000 cp such as 15,000-32,000 cp, or 15,000-25,000cp, 15,000-18,000 cp, or even 30,000-32,000 cp (higher zinc oxideconcentration). The latter ones with higher zinc oxide and/or boraxcontent (this due to the fact that the industrial production includesborax to increase viscosity and tack), can also be used, but topicalapplication requires an extra 2 minutes for it is a paste. Thedextrin-water mixture (having a solids content of, for example, 45-75%,preferably 55-70, especially 60-68%) is present in the formulation ofthe biological adhesive in an amount of about 80%-97% (e.g., 90-97% or80%-95%), preferably 92%-96%, by weight of the total formulation.

In the less viscous form (viscosity of, e.g., 12,000-16,000 cp), thesolid content of the dextrin/water mixture is, for example, 60-63%, andit has a pH of 8-9 with a tack time of about 10-14 min. This formulationworks well at room temperatures (e.g., 20-30° C.), does not requireheating and remains active for 6 months in a dry storage room. The moreconcentrated viscous forms having a viscosity of 30,000-33,000 cp, is inthe form of a paste, also works well in room temperature of 20-30° C.,and has a tack time of 4-6 min.

The adhesiveness modifier agent used in the biological adhesive of thepresent invention is preferably an insoluble metallic oxide powder. Asit is known in the art, borax is used in industrial processes to modifythe physical characteristics of dextrins such as, for example,viscosity, adhesiveness, solubility in the water, tack, etc.Nevertheless, the use of borax can produce adverse effects such asadhesion when it is in free direct contact with the intraperitonealstructures. It is known that diverse metal compounds such as calcium,iron, titanium, zirconium, and zinc can be incorporated into polymers toincrease the capacity of the polymers to adhere to tissues. Thesemetallic compounds preferably are insoluble in water and have anionizable charge in the surface where they are used. Incorporation ofthe metallic compound into the polymer can be achieved by mixing withthe polymer or by covering the polymer (“coating”)^(46,47). Also, it isknown that some polymers that contain metals actively adhere to tissuessuch as mesenteric, surrounding adipose tissue, a phenomenon we observedwith very viscous dextrins (30.000 cp or higher) when the biologicaladhesive is placed in the peritoneal cavity without a patch orinterphase of a biodegradable material.

Zinc oxide powder is a preferred adhesiveness modifier agent for use inthe biological adhesive dextrin-based of the present invention. Zincoxide has the approval of the FDA as a pharmaceutically acceptableadditive and can be ingested by humans without adverse collateraleffect. In addition, zinc oxide, due to its emollient, absorbentproperties, among others, is daily used in an endless number ofapplications such as treatment of wounds, decubitus ulcers, “diaperrash” in babies, etc. As mentioned previously, zinc oxide when added tothe polymer (dextrin) increases the biological adhesiveness of thepolymer, its tack, and diminishes the drying time, thus improving theproperties of the formulation as a biological adhesive to temporarilyprotect the anastomosis, or to fix a prosthesis used in herniaoperations. With a higher viscosity, e.g., 30,000 cp (or higher), thebiological adhesive is in the form of a paste which must be appliedwith, for example, a cotton tip applicator. Finally, zinc, as it is wellknown, is a very important ion in human metabolism and in the healingprocess.

The adhesiveness modifier agent is present in the biological adhesive ofthe present invention in a suitable amount to modify the adhesivestrength of the adhesive in such a way that the biological adhesiveremains temporarily in the anastomosis. In addition, the amount ofadhesiveness exhibited by the biological adhesive is suitable to promotehealing of the anastomosis. The adhesiveness modifier agent is presentin the formulation of the biological adhesive in an amount up to about19% by weight (e.g., 4-8% by weight), but preferably is about 2-6% byweight of the total formulation, and very preferably about 4 to 6% byweight of the total formulation. Also, the cost of zinc oxide is veryinexpensive, similar to the cost of dextrin.

Because there is solid experimental and clinical evidence that extensivebacterial invasion interferes with the healing process everywhere, theadhesive formulation of the present invention includes an antibiotic,preferably to avoid problems associated with bacterial invasion. Theinventor of the present invention has found that the preferredantibiotic agent for topical use is kanamycin due to its well-knownefficacy when used topically in the surgical wounds but more importantlybecause it has been used safely and extensively inside the abdominalcavity.

It has been known for many years, that the topical use ofintraperitoneal kanamycin in doses of 2-3 grams applied at the site ofmaximal bacterial contamination (for example, in the case of aperforated appendix, it is applied near the site of the stump) duringsurgery, may help prevent residual septic complications⁵⁶⁻⁵⁸. Recently,its successful use in topical form in the large incisions of bariatricsurgery—known for high risk for infection—has been reported, withoutadverse effects^(59,60). Kanamycin, used clinically by the intramuscularroute, in doses of from 1 to 2 g/day during 7 to 10 days, hasdemonstrated in time to be an effective and safe antibiotic. However,for the required antibiotic effects in the adhesive formulation of thepresent invention, the antibiotic agent is used in amounts that do notinterfere with the healing process. Preferably, the antibiotic agent ispresent in an amount of between 0.1 and 1% by weight of the totalformulation (for example, of 100 to 125 milligrams). In a particularlyand preferable modality of the invention, the antibiotic agent ispresent in amounts of between 0.2 and 0.5% in weight of the totalformulation (for example, of 250 to 500 milligrams single dose in thetopical application).

Other antibiotics are also suitable for use in the inventive compositionsuch as a 1^(st) generation cephalosporins like cefazolin. This popularand inexpensive antibiotic is used topically and subcutaneously toprevent incisional infections. Ann R Coll Surg Engl. May 1978;60(3):243-5.). Gentamycin, Clindamycin and Vancomycin are also suitableantibiotics. These agents are being used topically with collagen withgood results externally. (Phinney, R. B., Schwartz, S. D., Lee, D. A.,Mondino, B. J.: Collagen shield delivery of gentamycin and vancomycin.Archives of Ophthalmology, 1988. 106 pp. 1599-1604).

The formulation may also pharmaceutically acceptable adjuvants andexcipients. In addition, the formulation may contain further activeagents. For example, the formulation may contain growth factors, i.e.substances that in very small amounts can be placed in wounds tostimulate development of new vessels, namely angiogenesis which is vitalfor the development of new tissue such as collagen. Such growth factorsare derived mainly from macrophages present in the wound along withdifferent types of cytokines in the initial phase of the healing processand some of them are the platelet one (PDGF), a vascular GF (VEGF),Keratinocyte GF (wounds), etc. (te Velde E A, Voest E E, van Gorp J M,Verhemm A, Hagendoorn J, Gebbink M F, et al., Adverse effects of theantiangiogenic agent angiostatin on the healing of experimental coloniaanastomoses. Ann Surg Oncol 2002;9:303-9; Bennet N T, Schultz G S,Growth factors and wound healing: Part II. Role in normal and chronicwound healing. Am J Surg 1993;166:74-81).

A further example of an additional active agent is arginine. Arginine isan amino acid that plays a role in cell division, healing of wounds,improving immunity to illness, etc. It is used by the body to makenitric oxide, a substance that dilates blood vessels which plays animportant role in wound healing (Rizk M, Witte M B, Barbul A. Nitricoxide and wound healing. World J Surg 2004;28:301-6).

L. P. Fielding el al described in the British Medical Journal theresults of a large multicentric study in colo-rectal cancer surgery inwhich the concept of mini-leaks—which occur at a much higher rate thanpreviously thought in these anastomosis—is supported, and where theclinically relevant anastomotic leaks produced three times as muchmortality, expense and hospital stay^(62,63). Other reports havedemonstrated that although an anastomosis that tested well during theoperation and did not show a visible air or fluid leak (so-calledphysical impermeability), that does not mean that is completely sealedto prevent passage of bacteria and secretions into the peritoneal cavity(biological impermeability) as shown by A. Zaporozhets⁶⁴. In fact,mini-leaks not clinically relevant are shown in patients whenradio-opaque enemas are administered in the first 7 days postoperativelyand many of these leaks do not produce peritonitis. However, this mayexplain why some patients have a more torpid postoperative course,others develop a pericolic abscess later, and in some others anextensive adhesive process surrounds the area of the anastomosis.

In accordance with a method aspect of the invention, once an anastomosishas been finished and duly tested for its integrity, the biologicaladhesive of the present invention is applied, for example with a sterilecotton tip applicator, in a sufficient amount to cover completely thearea over the suture line. Then, a patch (an interphase) of cellulose orcollagen is preferably applied with sterile technique to cover the areain a way that adhesions with surrounding structures are avoided.Although in chronic animal experiments this method provides survival indefects not sutured, in humans once the anastomosis is completed andtested, the biological adhesive of the present invention is preferablyapplied with an interphase to reinforce the suture lines, to promotehealing during the critical period of several days when the anastomosisis held only by sutures and/or staples, in an area of acuteinflammation, with no collagen deposition, without any intrinsicstrength per se, and in a manner which will prevent the occurrence of adehiscence and/or mini-leaks. This is a very advantageous aspect of theinventive adhesive and method. A similar method can be used to fix theprosthesis in inguinal hernioplasties.

In another aspect of the invention, the method of application of thebiological adhesive based on dextrin can include, in addition, a patch,an interphase of sterile cellulose or collagen as a patch, in order toavoid adhesions with the surrounding organs and structures. Thesepatches that constitute the interphase are used very frequently inneurosurgery, orthopedic surgery, general surgery, etc. as haemostaticagents. This interphase is reabsorbed in 3 to 6 days.

In another modality of the present invention, some fistulas of differentetiology (e.g., gastric bypass) can also be closed from their orifice oforigin by endoscopic procedures using the biological adhesive of thepresent invention instead of re-operating on the patient, if theclinical situation so permits.

The entire disclosure of all applications, patents and publications,cited above and below, are hereby incorporated by reference.

EXAMPLE

The following examples are provided solely to illustrate the presentformulation, and are not intended to limit the scope of the invention.

A biological adhesive of the present invention was prepared in thefollowing way: Approximately 93-94% by weight of dextrin, 1-2% borax(industrially used in the production of maltodextrin), 0.4-0.5%formaldehyde (used in industrial formulations as an additive to make theadhesive more water-resistant and to slow bacterial growth duringstorage), 5% by weight of adhesiveness modifier agent, and 0.5% byweight of the antibiotic agent are added to a small container. Thepresence of borax and formaldehyde are not required in the inventiveformulation. Borax and formaldehyde are typically present in industrialproduced maltodextrin. The components are vigorously mixed together forabout 15 minutes using a mechanical agitator, until a homogenous mixtureor paste is formed. If a homogenous mixture does not form, the mixtureis warmed up until a temperature of, for example, between 23 to 30° C.to reduce the viscosity of the dextrin and allow the adhesivenessmodifier agent and antibiotic agent to properly mix with the dextrin.The antibiotic can also be added later separately, for example, justbefore the adhesive formulation is applied to the suture line.

RESEARCH SUPPORT OF THE INVENTION Protocol Approved by the School ofMedicine, Universidad Anahuac, Mexico City, February 2005

Phase 1

In the first phase, 250 to 300 g rats were used in acute experiments, inwhich, after an abdominal midline incision, 2 intestinal loops of 10 cmeach were isolated with 4-0 silk sutures. Then, a 3 mm incision was madein the antimesenteric edge, sutured with a single stitch of 6-0 silk. Atthe ends of the closed loop, a 16 gauge intravenous catheter wasintroduced and connected “in a Y” fashion to a central venous pressuremanometer and physiological serum was injected with a syringe, a methodsimilar to the one described by Arnold et al.⁶¹. FIG. 1 graphicallyshows the hydraulic pressure required to produce leakage in the suturedline in each group (1, 2 and 3). In group 1 the hydraulic pressurenecessary to produce leakage (“bursting pressure”) in the sutured area,ranged from 3-5 cm of water, whereas in group 2 in which a patch ofcellulose or of collagen of 3 mm² had been added, the hydraulic pressurenecessary to produce such a leak increased to 5-8 cm of water. In group3 the biological adhesive of the present invention was added to thepatch, which was let to dry 15 minutes. The pressures that were requiredto produce the leakage of liquid in group 3 increased to 18-45 cm ofwater, which was a statistically significant difference p: 0.05. (testANOVA). In each group 28 measurements were made.

In conclusion, in this phase 1, the biological adhesive of the presentinvention had a protective effect on the suture line, as demonstrated bya much higher hydraulic pressure being required to produce fluid leakagein group 3, as compared to groups 1 and 2.

Phase 2:

In sub acute experiments and using sterile techniques, in 250 to 300 grats, a 2 to 3 cm midline vertical incision was made and an intestinalloop was exteriorized. An incision of 3 mm was made in theantimesenteric edge. In group 1, a patch of cellulose or collagen of 3mm² was placed over the incision but without any suture or adhesive. Ingroup 2, a patch of cellulose or collagen of 3 mm², to which aneffective amount of the adhesive of the present invention was applied onthe surface, was placed over the incision. The abdominal incision wassutured using 4-0 polidioxanone in two layers. The rats were returned totheir cage and the survivors were observed for three weeks. The survivalrate in group 1 was 52%, whereas in group 2 the survival rate was 75%.

The purpose of phase 2 was to observe the tissue reaction, bothmacroscopically and microscopically, in the intestinal tissue. As can beseen in FIGS. 2 and 3, in the case of rats of group 1 that died in thefirst three days due to peritonitis, the well-known phenomena of intenseinflammatory reaction, cellular infiltrate and even intestinal defectwere observed (FIG. 2). In the necropsies of the surviving rats in thesame group, from the macroscopic point of view, multiple adhesions wereobserved to the abdominal wall and to the surrounding intestinal loopswith fibrosis, and the presence of giant cells was also observed. In 2cases large parietal abscesses were seen (FIG. 3). On the other hand, inthe surviving rats of group 2, it was impressive to observe an intactserous surface, and it was difficult or impossible to determine the sitewhere there had been a laceration and patch with adhesive of the presentinvention. Microscopically, the intestinal wall healed normally (FIG.4), and in these animals no inflammatory reaction or giant cells wereobserved, which makes us conclude that the adhesive of the invention isvery well tolerated and disappears after several days. As for thecellulose and/or collagen patch used frequently in general surgery,orthopedic surgery, neurological surgery, etc., it is known that itsreabsorption happens in the first 3 to 5 days after its application.

As a result of the experimental observations in phase 2, it is concludedthat the biological adhesive of the present invention was very wellaccepted by intestinal tissues of the rat and sometimes it wasimpossible to determine with certainty the exact site of the applicationof the patch with adhesive in the site of the injury.

Phase 3:

The observations made of Phases 1 and 2, were extended and applied todogs using sterile techniques. Preoperatively, 1 g intramuscular of asecond generation cephalosporin was applied. The technique involvedmaking a 6 cm vertical midline incision under the xyphoid appendix, and,by means of careful gastric traction, the duodenum was exteriorized.Then, a 5 to 6 mm² laceration was made in the antimesenteric edge usinga fine haemostatic clamp 4-5 cm distal to the pancreatic duct. Then, a 3cm 2 patch of cellulose or collagen was applied with the adhesive of thepresent invention over the laceration. After 12 min., the duodenum wasreturned to its normal position, that is, the laceration was notsutured, and a patch with the adhesive was applied over the defect. Theincision was then closed with 2-0 polidioxanone, a continuous suture intwo separated layers.

The animals were observed during 3 weeks and were sacrificed with anintravenous dose of sodic pentotal. In two occasions the autopsy tookplace 2 months later. Of a total of 28 dogs, 3 died in the first 72hours, the first 2 and 1 with an extended laceration. The macroscopicevaluation, in four surviving animals demonstrated minimum adhesions tofatty tissue. But, in the rest of the animals, at the site or theinjury, only a small scar was observed (FIG. 5). The microscopicsections, shown in FIG. 6, like in the previous phase 2 in rats,revealed a normal healing process of the intestinal wall, withoutinflammatory reaction or giant cells.

Phase 4:

Both in rats and in dogs the suture lines and the defects created in theduodenum and distal intestine not sutured but patched, were tested withhydraulic pressure at 8 days and the results were again the same: Thebiological adhesive of the present invention provided more strength toprevent “bursting” of the suture lines or defects as compared to thesites sutured and/or patched without adhesive formulation.

In conclusion, the temporary biological adhesive of the presentinvention protects the suture lines based on the fact that a greaterhydraulic pressure in Phase 1 is required to produce leakage of liquidin the suture line when the patch and adhesive were placed. This resultsin a greater survival rate in rats as shown in Phase 2. In Phase 2,there was an intense inflammatory reaction and cellular infiltrate inrats which died soon (Phase 2, group 1: patch alone). A chronicinflammatory process with giant cells was observed in surviving rats(Phase 2, group 1: patch alone), as compared with a normal healingprocess when the patch was applied with the adhesive of the presentinvention (Phase 2, group 2: patch with adhesive). In Phase 3, involvingdogs with a very serious, lethal injury in the duodenum, where it isknown that pancreatic and intestinal secretions exist, most animalssurvived and similar findings to those observed in rats were present,namely a normal healing process in the duodenal wall and site of theinjury. All of these results are proof that the adhesive of the presentinvention produces the necessary seal by its adhesive properties. InPhase 2 and in Phase 3, the macroscopic and microscopic findings weresimilar: the biological adhesive is very well tolerated by theintestinal tissues, external adhesions practically do not exist, andhistological signs of inflammation or giant cells were not observed. InPhase 2, it was practically impossible sometimes to determine the siteof the injury in the intestine of the rat, and in the dogs in Phase 3,only a small scar existed. Microscopically, an inflammatory reaction ora foreign body type of reaction did not exist. All of these results leadto the conclusion that the adhesive of the present invention is not onlyvery well tolerated, but is also biodegraded in 5 to 8 days after theapplication, precisely the critical period of intestinal healing in thecase of the mentioned gastrointestinal anastomosis.

Finally, in both, rats and in dogs using a similar experimental methodof Phases 1 and 3 at 8 days postoperatively, equal results were found:greater hydraulic pressures were required to produce leaks (“burstingpressure”) in the suture lines and sites of defects patched when theadhesive of the present invention was applied.

Although a form of specific accomplishments of the present inventionhave been described in detail with the previous examples, it must bestated that the present invention and formulations, are susceptible ofdiverse modifications and alternative forms of use, without separatingthem from the spirit and reaches of the present invention. Therefore,the intention is not to limit the invention and method herein described,but instead, to cover all the equivalent and/or alternativemodifications that fall within the reaches of the invention as it callsto each other by the annexed claims.

The preceding examples can be repeated with similar success bysubstituting the generically or specifically described reactants and/oroperating conditions of this invention for those used in the precedingexamples.

From the foregoing description, one skilled in the art can easilyascertain the essential characteristics of this invention and, withoutdeparting from the spirit and scope thereof, can make various changesand modifications of the invention to adapt it to various usages andconditions.

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1. A biological adhesive formulation comprising dextrin as a dispersion,at least one adhesiveness modifier agent, and at least one antibiotic,wherein said formulation contains 80-97 weight % of said dextrindispersion, and said dextrin dispersion contains 45-75% solids, based onthe total weight of the formulation.
 2. An adhesive formulationaccording to claim 1, wherein said formulation consists essentially ofsaid dextrin, said at least one adhesiveness modifier agent, and said atleast one antibiotic.
 3. An adhesive formulation according to claim 1,wherein said dispersion is a dispersion of said dextrin in water.
 4. Anadhesive formulation according to claim 1, wherein said formulationcontains 92-96 weight % of said dispersion, based on the total weight ofthe formulation.
 5. An adhesive formulation according to claim 1,wherein said dextrin dispersion has a solids content of 60-68%.
 6. Anadhesive formulation according to claim 1, wherein said dextrin has aviscosity of 12,000-33,000 cp.
 7. An adhesive formulation according toclaim 6, wherein said dextrin has a viscosity of 12,000-25,000 cp.
 8. Anadhesive formulation according to claim 4, wherein said dextrin has aviscosity of 12,000-18,000 cp.
 9. An adhesive formulation according toclaim 6, wherein said dextrin has a viscosity of 15,000-18,000 cp. 10.An adhesive formulation according to claim 6, wherein said dextrin has aviscosity of or 30,000-32,000 cp.
 11. An adhesive formulation accordingto claim 1, wherein said dextrin is a maltodextrin.
 12. An adhesiveformulation according to claim 1, wherein said at least one adhesivenessmodifier agent is an insoluble metal oxide.
 13. An adhesive formulationaccording to claim 1, wherein said at least one adhesiveness modifieragent is a calcium, iron, titanium, zirconium, cobalt or zinc compound.14. An adhesive formulation according to claim 12, wherein said at leastone adhesiveness modifier agent is zinc oxide.
 15. An adhesiveformulation according to claim 1, wherein said formulation contains 4-8%weight of said at least one adhesiveness modifier agent, based on thetotal weight of the formulation.
 16. An adhesive formulation accordingto claim 1, wherein said at least one antibiotic is kanamycin.
 17. Anadhesive formulation according to claim 1, wherein said formulationcontains 0.1-1 weight % of said at least one antibiotic, based on thetotal weight of the formulation.
 18. An adhesive formulation accordingto claim 17, wherein said formulation contains 0.2-0.5 weight % of saidat least one antibiotic, based on the total weight ofthe formulation.19. An adhesive formulation according to claim 1, wherein saidformulation contains up to 19 weight % of said at least one adhesivenessmodifier agent and 0.1-1 weight % of said at least one antibiotic, basedon the total weight of the formulation.
 20. An adhesive formulationaccording to claim 19, wherein said formulation contains 4-8% weight ofsaid at least one adhesiveness modifier agent, based on the total weightof the formulation.
 21. An adhesive formulation according to claim 19,wherein said at least one adhesiveness modifier agent is zinc oxide, andsaid at least one antibiotic is kanamycin.
 22. An adhesive formulationaccording to claim 1, wherein said formulation further comprises aninterface of cellulose or collagen.
 23. A method for promoting healingof tissue in a patient comprising applying to said tissue an adhesiveformulation comprising dextrin, at least one adhesiveness modifieragent, and at least one antibiotic.
 24. A method for promoting healingof tissue in a patient comprising applying to said tissue an adhesiveformulation according to claim,
 25. A method for preventing dehiscenceof an anastomosis or a surgical wound in a patient, comprising applyingto said anastomosis or surgical wound an adhesive formulation comprisingdextrin, at least one adhesiveness modifier agent, and at least oneantibiotic.
 26. A method for preventing dehiscence of an anastomosis ora surgical wound in a patient, comprising applying to said anastomosisor surgical wound an adhesive formulation according to claim
 1. 27. Amethod according to claim 25, wherein said wound is within the digestivesystem and said adhesive formulation protects against dehiscences ofanastomosis of the digestive system.
 28. A method of affixing aprosthesis during a hernia operation in a patient, comprising applyingto said prosthesis an adhesive formulation comprising dextrin, at leastone adhesiveness modifier agent, and at least one antibiotic.
 29. Amethod of affixing a prosthesis during a hernia operation in a patient,comprising applying to said prosthesis an adhesive formulation accordingto claim
 1. 30. A method according to claim 28, wherein said herniaoperation is for an inguinal hernia.
 31. A method for occluding afistula within a patient comprising applying to said fistula an adhesiveformulation comprising dextrin, at least one adhesiveness modifieragent, and at least one antibiotic.
 32. A method for occluding a fistulawithin a patient comprising applying to said fistula an adhesiveformulation according to claim 1.